Antiplatelet agents and survival: a cohort analysis from the Studies of Left Ventricular Dysfunction (SOLVD) trial.
OBJECTIVE
This study sought to evaluate the relation between antiplatelet agent (APA) use and survival and morbidity from cardiac disease in patients with left ventricular (LV) systolic dysfunction.


BACKGROUND
APAs play an important role in the prevention and treatment of coronary disease. Their effects in patients with LV systolic dysfunction are unknown.


METHODS
We reviewed data on APA use in 6,797 patients enrolled in the Studies of Left Ventricular Dysfunction (SOLVD) trial and analyzed the relation between their use and all-cause mortality as well as the combined end point of death or hospital admission for heart failure (HF). We used Cox regression to adjust for differences in baseline characteristics and to test for the interaction between APA use and selected patient variables in relation to outcome.


RESULTS
APA use (46.3% of patients) was associated with significantly reduced mortality from all causes (adjusted hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.73 to 0.92, p = 0.0005) and reduced risk of death or hospital admission for HF (adjusted HR 0.81, 95% CI 0.74 to 0.89, p < 0.0001) but was not influenced by trial assignment, gender, LV ejection fraction, New York Heart Association class or etiology. A strong interaction was observed among APA use, randomization group and all-cause mortality. The association between APA use and survival was not observed in the enalapril group, nor was an enalapril benefit on survival detectable in patients receiving APAs at baseline. However, randomization to enalapril therapy significantly reduced the combined end point of death or hospital admission for HF in APA users.


CONCLUSIONS
In patients with LV systolic dysfunction, use of APAs is associated with improved survival and reduced morbidity. This association is retained after adjustment for baseline characteristics. APA use is associated with retained but reduced benefit from enalapril.
Al-Khadra
A S
AS
Department of Medicine, New England Medical Center Hospitals, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
Salem
D N
DN
Rand
W M
WM
Udelson
J E
JE
Smith
J J
JJ
Konstam
M A
MA
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002303:Cardiac Output, Low / Q000209:etiology / Q000503:physiopathology; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D003327:Coronary Disease / Q000188:drug therapy* / Q000401:mortality; D016757:Death, Sudden, Cardiac / Q000209:etiology; D004311:Double-Blind Method; D004656:Enalapril / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010343:Patient Admission; D010919:Placebos; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012044:Regression Analysis; D012307:Risk Factors; D012737:Sex Factors; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D016277:Ventricular Function, Left / Q000502:physiology
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D010919:Placebos; D010975:Platelet Aggregation Inhibitors; D004656:Enalapril